Summer - United States Special Operations Command

vice can be removed and the core body temperature willremain at a constant lowered value for hours. 21 Thisportable cooling system is presently the fastest coolingavailable and is comparable to controlled ice water immersion.(see Figure 1)TRIALSFigure 1: ICE ImmersionTo date, clinical results have been conflicting;many reports have been unable to reach proper efficacy inhuman trials due to a lack of comparable data betweencontrol and treatment groups. In association with this,different trials have used unique temperature goals fortreatment, different methods and times to reach suchgoals, and different durations at therapeutic temperature. 22In 2001 a clinical trial by Clifton et al. presentedno significant neurological outcome difference in severebrain injury patients who were treated with mild hypothermiacompared to a normothermic control group. Inthis study the experimental group reached the therapeutictemperature goal of 33°C in the mean time of 8.4 ± 3.0hours. 23 Results of Markgraf et al. (2001) study suggeststhat early initiation of hypothermic medicine within onehour of an induced traumatic brain injury with rats, improvedneurological outcomes when the body was cooledto 30°C. The therapeutic device utilized in this studyachieved hypothermic target temperatures within threehours. Overall this meant that target core body temperatureswere reached in less than four hours. When initiationoccurred after 90 minutes, there was no observedchange in neurological outcome. 9An ongoing study by Clifton et al. is examiningthe impact on neurological outcome of using hypothermicmedicine to centrally cool the body to 33°C withinfour hours of traumatic brain injury and then maintainingthat temperature for 48 hours. 24CONCLUSIONTBI is considered by many to be the “signaturewound” of the present conflicts in Iraq and Afghanistan,thus, further understanding of the mechanisms of injuryand the treatment for such is imperative to militarymedical personnel.While Soldiers may remain stable after the primaryinjury, progressing secondary mechanisms canproduce neurological degeneration. Results of preliminarystudies with hypothermic medicine suggest thatthis treatment may reduce some of the secondary mechanismsof TBI and also be an effective treatmentthrough other means.To date the clinical trials of therapeutic hypothermiahave given mixed results. Results in animalstudies of Markgraf et al. (2001) indicate that early inductionof mild hypothermia could produce neuroprotectiveabilities, when target core body temperatures arereached within four hours after an induced neurologicalassault. If continued, a National Institute of Health clinicaltrial by Clifton et al. may be modified to achievetherapeutic temperatures of 33°C with the new fastestcooling portable system clinically available. While previouslyimpossible to obtain such timely new treatment,advances in technology give new opportunities to answerthe questions we have posed concerning preventionof secondary injury, and if the data is supportive ofthis concept, an opportunity to implement a field-readysystem that has the potential for forward deployment.REFERENCES1. Landers, Susan J. (2009). Traumatic brain injury has becomethe signature wound of the wars in Iraq andAfghanistan, yet its effects are often overlooked. AmericanMedical News. Posted on Jan. 5, 2009.2. Betty Clooney Foundation Website. (2009). Retrievedfrom http://www.bcftbi.org/aboutSoldiers.asp, on May 3,2009.3. Army News Service. (2009). Most Soldiers with traumaticbrain injury heal. March 4, 2009.4. Soldiers story of traumatic brain injury. (2005). Retrievedfrom http://www.wsoctv.com/health/5392779/detail.html.5. Hardman JM, Manoukian A. (2002) Pathology of headtrauma. Neuroimaging Clinics of North America; 12(2):175–87.6. Park E, Bell J, Baker A. (2008) Traumatic brain injury:Can the consequences be stopped? Canadian Medical AssociationJournal; 178 (9).7. Stocchetti N, Colombo A, Ortolano F, et al. (2007). Timecourse of intracranial hypertension after traumatic braininjury. Journal of Neurotrauma; 24:1339-1346.8. Jiang JY, Lyeth BG, Kapasi MZ, Jenkins LW, PovlishockJT. (1993) Moderate hypothermia reduces blood-brainbarrier disruption following traumatic brain injury in therat. Acta Neurophalol; 84:495-500.24Journal of Special Operations Medicine Volume 9, Edition 3 / Summer 09